Haven Medical Group Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HAVEN MEDICAL GROUP INC.

Practice address

1332 W Herndon Ave Ste 101
Fresno, CA 93711-7118

Phone

(682) 433-9287

NPI assigned

Aug 27, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Justice Otchere, MD

Title

Medical Director

Phone

(682) 433-9287

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1437826211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1332 W HERNDON AVE STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937117118",
            "telephone_number": "682-433-9287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1332 W HERNDON AVE STE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937117118",
            "telephone_number": "682-433-9287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "OTCHERE",
        "authorized_official_first_name": "JUSTICE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "682-433-9287",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shisheer Havangi Prakash, MBBS
• Jason Michael Havay
• Haven Assisted Care LLC
• Haven Health Partners
• Haven Hills Center LLC
• Havens Orthodontics, Inc.
• Bruce Havens, D.D.S
• Kelley Young Havens, P.T.
• Gary Havlicek, CRNA
• Carol Lee Havner

• Internal Medicine Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.